New born ExaminationNew born Examination

What you have to look for…..

Lecture for medical undergraduates

ObjectivesAt the end of lecture, the student • should understand the importance of new-

born examination.

• Should be aware of some normal conditions that cause parental anxiety.

• Should be able to do a new born examination systematically and detect congenital and acquired abnormalities.

Why is it necessary ?

1. To detect congenital anomalies.

3- 5% of newborns

2. To detect some acquired abnormalities.

E.g: umbilical sepsis

3. Reassure parents when normal findings are

detected.

Eg: erythema toxicum

• 4. Identifies familial conditions– DDH

• 5. Analysis of findings will identify the problems specific to regions/ ethnic/ age groups– This is particularly important in policy

making & preventive strategies

When would you do it ?

• As soon as possible after delivery

• Before discharge

• At 6/52

Important..• Wash your hands first & dry them

• Examination of newborns

requires patience

gentleness

procedural flexibility

• If the baby is quiet auscultate the heart first

• Disturbing manipulations to be done last

New born examination is done from head to toe.

Observe the baby

• General posture

• Colour

Pink

Acrocyanosis

Pallor

• Appearance of skin

Vernix

Lanugo hair

Nails

• Activity

Normal or diminished

Tremulous movements

Head* Size and shape to be noted

1. Fontanellewidebulging - tensionclosed

2. Suturesoverridingwidely separated > 5 mm

3. Cephalhaematoma bleeding under periosteum on the parietal bones does not cross the midline

Cephalhaematoma

5. Caput succedaneum

echymotic, oedematous swelling of

soft tissues

crosses the midline

disappears after first few days

Head Contd..

Caput succedaneum

6. Encephalocele

Head Contd..

Face1. Dysmorphic features

– Down’s :epicanthal folds, hypertelorism, low set ears– Other syndromes

2. Oedema – face presentation– prolonged labour

3. Isolated abnormalities– Mouth: precocious dentition/ cleft lip / palate/ Epstein pearls (self

resolving white inclusion cysts on palate/gums)– Ear abnormalities (deformities, preauricular skin tags)– Eye: cataract – red reflex, conjunctival / retinal haemorrhaege– micrognathia

4. Facial nerve palsy

Down’s syndrome

Mid-line defects in trisomy 13

Prominent occiput & low-set ears in trisomy 18

Bilateral cleft lip

&

complete cleft palate

pre-auricular skin tags

Acute bacterial conjunctivitis

Cataract in Rubella syndrome

Unilateral microcornea & microphthalmos

Unilateral iris coloboma in left eye

Micrognathia

Right facial nerve palsy following birth injury

Neck

1. Goitre

correct technique

– slightly extended neck

2. Sternomastoid tumour

after ~ 1/12 of age.

torticollis

3. Cystic hygroma

Chest• Breast

breast hypertrophy

mastitis neonatorum

super numerary nipples

• Chest deformities

• Observe breathing pattern

• Dyspnoea and grunting

• Heart : examine both sides

location

heart rate

peripheral pulses

Abdomen

• Abdominal distension

• Scaphoid abdomen

• Liver – palpable

• Unusual masses

Abdomen contd.

• Umbilicus

umbilical sepsis

omphalocele

later – umbilical hernia

gastrochiasis

Abdomen Contd..

• Bladder exstrophy

• Cloacal exstrophy

Groin

• Femoral pulses

– to exclude coarctation

• Hip examination

– to exclude CDH

Ortolani manoeuvre

abducting the femur

– palpable clunk

Asymmetrical thigh creases in

unilateral dislocation of hip

Genitalia• Ambiguous genitalia

• Undescended testes

• Hypospadias

• Hydrocele

• Imperforated anus

• Inguinal hernia

Ambiguous genitalia

Hypospadias

Imperforated anus

Hydrocele

Inguinal hernia

High imperforated anus communicates into vagina

Imperforate hymen

Limbs• Observe for spontaneous or stimulated activity

• Polydactyly

• Syndactyly

• Nerve damage

• Talipes (Club foot): CTEV

• Other abnormalities

• Erb’s palsy

• Amniotic band defects

Turner syndrome

Low hairline

Abnormal ears

Neck webbing

Micrognathia

Shield chest with widespread nipples

Lymphoedema in hands & feet - Turner syndrome

Rocker-bottom feet (protruding calcanei) intrisomy 18

Overlapping fingers in trisomy 18

Polydactyly

Syndactyly

Lobster claw hand

Amniotic band defects

Talipes equino varus

Erb’s palsy

Spine

• Kyphoscoliosis

• Feel for defects

• Tuft of hair-Spina bifida occulta

Back / spine contd….

• Meningomyelocele

Skin• Pustules

Skin Contd..

• Milia

- Sweat retention vesicles

• Thrush

- oral

- nappy rash – satellite lesions

Skin Contd..

Skin Contd..

• Mongolian blue

spots

Skin contd..

• Haemangioma

Skin Contd..

• Amoniacal dermatitis

• Erythema toxicum

Skin contd..

• Seborrhoeic dermatitis

Skin contd..

Skin contd..

• Sweat rash

Skin contd..

• Cutis marmorata

Skin contd..

• Stork bite

Anthropometric measurements

• Length

– infantometer

• Weight

• OFC

New born reflexes

• Rooting

• Sucking

• Grasp

• Moro

– gradually disappear by 4/12

• Asymmetrical tonic

neck reflex

- Appear at 2- 4/12

- Disappear by 6/12

You CAN’T miss1. Red reflex: Cataract

2. Femoral pulse: coarctation of aorta

3. DDH

• As missing any of the above in new borne examination does much harm than missing anything else.

Summary

• New born examination is important in all babies to exclude congenital abnormalities & acquired infections.

• All babies should be examined before discharge.

• Thorough examination should be done from head to toe.

• If abnormalities were detected, can take early actions to correct them. Eg: DDH,CTEV

• Parents can be reassured if normal variations were found. Eg: Erythema toxicum